One change in the microsystem that occurred in my professional practice was the
introduction of hourly patient rounding on a medical-surgical unit. Earlier, there was no
consistency in rounding, nor was it always based on the preference of nurses. The change
standardized the process by ensuring that the staff checked on patients at regular intervals
through the use of the 4 Ps (pain, position, personal needs, and placement of items).
At the mesosystem level, this enhanced communication among units, and in particular
when nurses transferred patients to ancillary departments such as radiology or physical therapy.
The uniformity in the monitoring of patients minimized confusion and simplified work
processes. At the macrosystem level, the organization experienced tangible patient satisfaction
scores, reduced fall rates, and improved quality data that had an impact on reimbursements and
regulatory reporting.
The systems-thinking skills, knowledge, and attitudes that were exhibited by the leader
who spearheaded this change were quite important. She was familiar with evidence-based
practice, and she provided literature on how the implementation of purposeful rounding
positively affected patient outcomes. Her abilities were in clear communication, team building,
and change management, whereas her attitudes were patience, persistence, and respect for the
concerns of staff. She proactively modelled the conduct, did follow-up audits, and established
feedback loops where staff could give their feedback, which created a culture of collective
ownership.
To a great extent, these acts helped in the execution of the leader involved the staff at an
early stage and listened to their opinions, which reduced tension and fostered confidence. There
were obstacles such as the feeling of being overwhelmed by staff due to the new documentation
requirements. Nevertheless, the leader was able to adjust and made charting easier, as well as
provide training sessions, which strengthened sustainability.
My new understanding, therefore, is that the changes made at the microsystem level
extend through the meso- and macrosystems in a very strong manner. In managing change within
a complex adaptive system, I identify that there should be a balance between standardization and
flexibility as a future leader. Any change should not only be efficient, but it should also take into
consideration human aspects of care.
The strategies that I would employ to implement change in the future include readiness
assessments to determine how much staff can handle, pilot programs to test the idea, and
introduction of hourly patient rounding on a medical-surgical unit. Earlier, there was no
consistency in rounding, nor was it always based on the preference of nurses. The change
standardized the process by ensuring that the staff checked on patients at regular intervals
through the use of the 4 Ps (pain, position, personal needs, and placement of items).
At the mesosystem level, this enhanced communication among units, and in particular
when nurses transferred patients to ancillary departments such as radiology or physical therapy.
The uniformity in the monitoring of patients minimized confusion and simplified work
processes. At the macrosystem level, the organization experienced tangible patient satisfaction
scores, reduced fall rates, and improved quality data that had an impact on reimbursements and
regulatory reporting.
The systems-thinking skills, knowledge, and attitudes that were exhibited by the leader
who spearheaded this change were quite important. She was familiar with evidence-based
practice, and she provided literature on how the implementation of purposeful rounding
positively affected patient outcomes. Her abilities were in clear communication, team building,
and change management, whereas her attitudes were patience, persistence, and respect for the
concerns of staff. She proactively modelled the conduct, did follow-up audits, and established
feedback loops where staff could give their feedback, which created a culture of collective
ownership.
To a great extent, these acts helped in the execution of the leader involved the staff at an
early stage and listened to their opinions, which reduced tension and fostered confidence. There
were obstacles such as the feeling of being overwhelmed by staff due to the new documentation
requirements. Nevertheless, the leader was able to adjust and made charting easier, as well as
provide training sessions, which strengthened sustainability.
My new understanding, therefore, is that the changes made at the microsystem level
extend through the meso- and macrosystems in a very strong manner. In managing change within
a complex adaptive system, I identify that there should be a balance between standardization and
flexibility as a future leader. Any change should not only be efficient, but it should also take into
consideration human aspects of care.
The strategies that I would employ to implement change in the future include readiness
assessments to determine how much staff can handle, pilot programs to test the idea, and
